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Bhutia S.,The Townsville Hospital
The Cochrane database of systematic reviews | Year: 2013

In the initial treatment of venous thromboembolism (VTE) low molecular weight heparin (LMWH) is administered once or twice daily. A once daily treatment regimen is more convenient for the patient and may optimise home treatment. However, it is not clear whether a once daily treatment regimen is as safe and effective as a twice daily treatment regimen. This is the second update of a review first published in 2003. To compare the efficacy and safety of once daily versus twice daily administration of LMWH. For this update the Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last searched May 2013) and CENTRAL (2013, Issue 4). Randomised clinical trials in which LMWH given once daily is compared with LMWH given twice daily for the initial treatment of VTE. Two review authors assessed trials for inclusion and extracted data independently. Five studies were included with a total of 1508 participants. The pooled data showed no statistically significant difference in recurrent VTE between the two treatment regimens (OR 0.82, 0.49 to 1.39; P = 0.47). A comparison of major haemorrhagic events (OR 0.77, 0.40 to 1.45; P = 0.41), improvement of thrombus size (OR 1.41, 0.66 to 3.01; P = 0.38) and mortality (OR 1.14, 0.62 to 2.08; P = 0.68) also showed no statistically significant differences between the two treatment regimens. None of the five included studies reported data on post-thrombotic syndrome. Once daily treatment with LMWH is as effective and safe as twice daily treatment with LMWH.


Croese J.,The Townsville Hospital | Gaze S.T.,James Cook University | Loukas A.,James Cook University
International Journal for Parasitology | Year: 2013

We recently completed clinical trials in people with diet-treated celiac disease who were purposefully infected with the ubiquitous human hookworm, Necator americanus. Hookworm infection elicited not only parasite-specific immunity but also modified the host's immune response to gluten. After infection, mucosal IL-1β and IL-22 responses were enhanced, but IFNγ and IL-17A levels and circulating regulatory T cells following gluten challenge were suppressed, and the adaptive response to gluten acquired a helper T cell type-2 profile. In this review, we briefly, (i) highlight the utility celiac disease offers autoimmune research, (ii) discuss safety and personal experience with N. americanus, (iii) summarise the direct and bystander impact that hookworm infection has on mucosal immunity to the parasite and gluten, respectively, and (iv) speculate why this hookworm's success depends on healing its host and how this might impact on a propensity to autoimmunity. © 2013 Australian Society for Parasitology Inc.


Smith J.,The Townsville Hospital
Neonatal network : NN | Year: 2013

The maintenance of a constant body temperature is important to all humans but even more so for newborn babies (neonates), especially those born pre-term. Because accurate measurement of body temperature is an important component of thermoregulation management in the neonate, a review of the literature was undertaken to determine the most appropriate method and site of temperature measurement in both the preterm and term neonate. The available evidence indicates that the axilla remains the most common place for temperature measurement.


Close B.R.,The Townsville Hospital
The American journal of emergency medicine | Year: 2012

A 23-month-old boy was brought to the emergency department of an adult and pediatric tertiary care center 1 hour after an inadvertent " double dose" of 120 mg flecainide (9.2 mg/kg). His electrocardiogram revealed sinus rhythm with a terminal R wave in aVR greater than 7 mm, a bifascicular block, and prolonged QRS and QTc intervals. A dramatic improvement in the bifascicular block and terminal R wave occurred after the administration of sodium bicarbonate. He was discharged after 36 hours with no complications. This case demonstrates that flecainide can cause significant cardiac conduction disturbances in doses much lower than previously described. All supratherapeutic ingestions should be assessed in hospital.


Yau S.,The Townsville Hospital
Australian Family Physician | Year: 2015

Background Epistaxis is one of the most common ear, nose and throat (ENT) emergencies to present to general practitioners (GPs). The management of epistaxis has evolved significantly in recent years, including the use of nasal cautery and packs. Successful treatment requires knowledge of nasal anatomy, and potential risks and complications of treatment. Objective Epistaxis is often a simple and readily treatable condition. However, given the potential consequences of a significant bleed, GPs should have an understanding of the causes, potential risks and emergency management. Discussion Epistaxis can be classified into anterior or posterior bleeds, the former being the most common. Anterior bleeds can often be treated with cauterisation with silver nitrate sticks, provided there is good preparation, correct equipment and assistance close at hand. If there is a lack in any of these aspects, prompt use of nasal packing and referral to an emergency department or a specialist ENT service is recommended. © The Royal Australian College of General practitioners 2015.

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